Individual
DR. TODD BRADLEY GORDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1618 CANYON CREEK DR, SUITE 120, TEMPLE, TX 76502-3275
(254) 791-2020
(254) 791-2025
Mailing address
1618 CANYON CREEK DR, SUITE 120, TEMPLE, TX 76502-3275
(254) 791-2020
(254) 791-2025
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
F1594
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102603103
—
TX
01
—
8B0830
BLUE CROSS BLUE SHIELD
TX
Enumeration date
02/09/2006
Last updated
07/08/2007
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